R011 Rev. 2/03 dms
P.O. BOX
PORT
PHONE: 610-562-2100 FAX: 610-562-1922
Car initial & Number:
__________ Kind:
______________ Load - Empty Date: _________
(circle one)
To Station/City:
Rail Routing:
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From Station/City:
Shipper:
________________________________________________________________________
Consignee/Company car is
going to: __________________________________________________
Destination Station/City: ____________________________________________________________
Prepaid – Collect STCC Number:
________________________________________________
(circle one)
Seal Numbers:
_____________________________
Description of load: ______________________
Number of
packages/pieces/items: __________________________ Weight: ___________________
Rail Contract or Tariff
Number: ________________________________________________________
Special Shipping
Instructions: _________________________________________________________
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